British Columbia’s provincial government has ended its take-home safe supply program for new participants, with an intention to transition existing patients to witnessed ingestion too.
The program provides pharmaceutical drugs, mostly opioids, to protect people who use drugs from the acute risks of the adulterated street supply. Some recipients could previously bring their drugs home to use at their doctors’ discretion; now, new clients are immediately required to take them at pharmacies or clinics, under the supervision of a pharmacist. That restriction is intended to extend to the entire program.
The abrupt reduction in access can be read as the government continuing its retreat from harm reduction in response to right-wing pressure. It’s a move people who use drugs and researchers say will be devastating for those who rely on safe supply—including those who use diverted medications, whether from safe supply programs or elsewhere.
“There’s been a lot of panic,” Juls Budau, a freelance researcher doing her master’s in social work, told Filter. A former frontline harm reduction worker, Budau has a hydromorphone prescription through the safe supply program.
The province made the announcement on February 19, citing “diversion.” Health Minister Josie Osborne said in a press release that safe supply medications need to be “used by the person they’re intended for.”
Right-wing journalists and politicians have claimed for years that diversion is widespread, and that it’s causing a wave of new addictions, including among children.
Proponents of safe supply acknowledge that diversion does occur, but there’s no evidence it’s leading to an increase in addiction. Diverted medications are often used by people who need them for the same reasons as those who have been able to obtain a prescription, including by loved ones of those with a prescription.
“This will undoubtedly result in deprescribing and forced tapering.”
According to the BC Centre for Disease Control, rates of new opioid use disorder diagnoses among youth aged 19 to 24 in BC declined between 2020 and March 2023, from a level which was already substantially lower than the mid-2010s.
The same was more or less true for every other adult age group, while diagnoses among those aged 18 and under saw no significant change.
Hydromorphone, one of the most common safe-supply opioids, was meanwhile detected in just 3 percent of unregulated drug-related deaths in 2024, according to the BC Coroners Service.
As the government cracks down on safe supply based on unsubstantiated claims of harm, advocates expect real harms to result from the crackdown itself.
“This will undoubtedly result in deprescribing and forced tapering,” said the advocacy group Moms Stop the Harm on Instagram.
This comes as the number of safe supply prescriptions has already seen a steep drop from its peak of nearly 5,200 patients in March 2023 down to just under 3,900 in December 2024, according to the BC Centre for Disease Control’s harm reduction dashboard.
Deprescribing would lead to more people relying on the toxic illicit drug supply, which is driving the public health emergency from overdose deaths.
Bardwell’s research found that clients of clinics offering take-home hydromorphone are less likely to buy from the illicit drug supply.
Dr. Geoff Bardwell, associate professor of health sciences at the University of Waterloo, said the policy change will impact rural and remote drug users most of all.
Bardwell’s research, looking at the small, rural cities of Duncan and Kamloops, has found that clients of clinics offering take-home hydromorphone are less likely to buy from the illicit drug supply at night when the clinics are closed.
While places like Vancouver have relatively reliable transit that people can use to access a clinic, most rural and remote locations have far less access to transportation.
Some anti-safe supply advocates have noted that methadone is usually a witnessed dose, to suggest that hydromorphone should be as well, but Budau noted that the two drugs are not the same.
While methadone is a long-acting drug—people need only attend the clinic once a day—hydromorphone requires multiple doses every day.
“If you have to be somewhere five times per day, you’re essentially living there. You have to stay there,” Bardwell told Filter. “We know that take-home doses provide people with an option so they don’t have to live at a clinic.”
Budau said she’s also concerned that the province hasn’t allocated any resources to accommodate the change, pointing to the prior example of BC’s limited decriminalization pilot.
“The purpose of decrim, explicitly from the government, was they wanted more people to access harm reduction services,” she said, and an evaluation of decriminalization performed by the Canadian Association of Mental Health asked services like overdose prevention sites and others if they were getting more clients.
“All of them had increased services and increased clientele after decrim,” she noted, yet, “almost none of them received an increase of any funding or staffing.”
“I can’t imagine what this is going to do to people. People are going to stop going. It’s going to leave them with the unregulated drug supply.”
Forcing people on safe supply to go to the clinic for every dose is going to put an added burden on staff, she said—a point Bardwell echoed.
While the removal of take-home safe supply is effective immediately only for new clients, the BC Centre on Substance Use is working on the plan to push all existing clients onto witnessed ingestion as well, Budau said.
That would mean a significant influx to clinics—which, again, will disproportionately impact workers at rural and remote clinics, according to Bardwell.
“Especially in the rural setting, you already have health care workers that are stretched thin,” he said. “It’s not like this policy change came with additional dollars to pay for more nursing staff, more people working to provide this dosing.”
But it will also mean more people dropping off of safe supply altogether, Bardwell expects.
“So, I can’t imagine what this is going to do to people,” he said. “I can’t imagine. People are going to stop going, and where’s that going to leave them? Well, it’s going to leave them with the unregulated drug supply.”
“The programs aren’t going to work,” he continued. “They might work for people that live around the corner. But it’s just ridiculous thinking about all of these different facets and effects that one policy change will have. And it just seems very short-sighted.”
Budau said safe supply wouldn’t have worked for her if she hadn’t had the ability to carry doses home.
Budau described developing an addiction following post-traumatic stress disorder from her time as a frontline worker. And she said safe supply wouldn’t have worked for her if she hadn’t had the ability to carry doses home.
“I was in a very different place when I started [safe supply],” she said, “and I think that if I had to leave the house and interact with lots of people—and especially because the pharmacy can be a very judgmental place that doesn’t feel very good to be at when you’re an [opioid agonist therapy] patient—I don’t think I would have been able to make it there every single day.”
She also doesn’t know how she could do daily witnessed ingestion today.
As a researcher she attends conferences, and witnessed ingestion would make that travel either cumbersome or impossible.
“Are they just going to stop people from travelling, living their lives, going to work?” she said. “A lot of people are panicking.”
And it isn’t just people on safe supply. Budau said she’s received calls from people on suboxone and methadone, fearful that they were going to have to change their entire lives to work with the new policy.
Budau was able to confirm for them that the changes don’t impact those patients, but it’s indicative of the broader confusion caused by the government’s anti-harm reduction moves.
She’s additionally concerned that a rush of people on hydromorphone to the illicit market will spur a new round of increased drug toxicity.
After a mass-deprescribing from pain medications in the mid-2010s—along with a change in the methadone supply that led many patients to revert to the illicit market—increased illicit-market demand was met with a shift in the supply to fentanyl.
Budau now fears an increase in counterfeit pills marketed as hydromorphone.
“As we restrict more and more drugs, now we’re seeing nitazines, we’re seeing more and more xylazine in the supply,” she said.
“It’s very scary. It’s wild that this is the focus, hydromorphone.”
Photograph (cropped) by Mariano Baraldi via Unsplash
Correction, February 24: This article has been edited to correct a quotation from Juls Budau, which originally read “outpatient” when it should have been OAT patient.
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